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HEALTH REFORM: Follow Up Questions with Governor Sebelius

During her hearing before the Senate Finance Committee, Secretary of HHS-designate Kathleen Sebelius responded to Senator Schumer's questions regarding whether Americans should be able to choose between public and private health plans, by noting such a situation of fair competition already exists in over 30 state employee benefit plans.

In her written follow-up to the questions submitted for the record by the Finance Committee, Sebelius addressed some of the Republican concerns about the public health insurance plan. In response to a question from Senator Kyl on whether a public plan was necessary to insure all Americans, Sebelius explained some of  President Obama's thinking when he included the idea of a public health insurance plan among his campaign proposals:

The President‘s campaign plan proposed a public option alongside private insurance options in a National Health Insurance Exchange. He recognizes the importance of giving the American people this choice, which would also challenge private insurers to compete on cost and quality, not cream-skimming and risk selection.

Sebelius also addressed Senator Ensign's concerns about the ability of private plans to compete with a public health insurance, stressing the importance of "maintaining a level playing field" and stating "the public plan option should pay providers competitive rates, and the private plan options should be barred from cherry-picking the healthiest enrollees." Sebelius had similar responses to Senator Grassley's questions on the issue, making clear that "the President is open to good ideas from both sides of the aisle, and he will work with Congress on this and other elements of the plan."

While the issue of a public health insurance plan has figured prominently in earlier coverage of the health reform debate, only a handful of the 209 questions posed to Sebelius by members of the Senate Finance Committee were about a public plan. Here's a brief sampling of Sebelius response to some of the major health reform questions:

On Financing:

The President believes we can‘t afford not to reform our health care system. The crushing costs of health care are making it harder for families to make ends meet, and they‘re making it harder for businesses to compete in the 21st century. In the last eight years, premiums have nearly doubled. And, health costs are a major cause of our long-run fiscal deficit.

Modernizing our health care system and ensuring affordable coverage will require an up-front federal investment. The President‘s budget includes policies to help offset this investment. Moreover, health reform, along with the Recovery Act investments, will yield long-run cost savings for both taxpayers and the federal government. Our goal is to fix our broken system in a fair and fiscally responsible manner, covering all Americans and lowering the long-run growth of health care.

On Reconciliation and Bipartisanship:

The President has been clear that he hopes that we can turn the page to a new era of bipartisan cooperation in Washington. The commitment to bipartisanship extends to health reform. This will be one of the largest undertakings of this Congress, and we hope to find common ground. There are many tools available and none of those tools, including reconciliation, should be taken off the table. The White House—and I, if confirmed—look forward to working with Congress to achieve a bipartisan solution to the health system crisis.

On Comparative Effectiveness:

Comparative effectiveness will help patients and providers make informed health care decisions based on effectiveness and appropriateness of treatments. It is about empowering patients and providers with the best information. Business groups, some provider groups, and members of Congress in both parties support this effort because it will improve the performance of the health system. We must disseminate information on the best medical practice for people in a way that ensures effectiveness. Comparative effectiveness research is about spreading information on what‘s most effective; it has nothing to do with government‘s dictating choices.

 On the Delivery System and the Coordination of Care:

There are a number of initiatives that can ensure effective coordination of care for patients with multiple chronic conditions, several of which have received funding through the American Recovery and Reinvestment Act. First, the creation of an interoperable health information technology system will allow improved communication across providers. Second, health training programs will build a 21st-century health workforce capable of meeting the needs of our aging population. Third, comparative effectiveness research will provide patients and providers with information on what works best to treat diseases. And fourth, prevention and disease management will keep our populations healthier, longer. If confirmed, I look forward to working with you to build on this investment to achieve the goal of high-quality care for patients with multiple chronic conditions.

Sebelius' answers fill up 137 pages of text, with a scope and range reflecting not only the breadth of her duties at HHS but also the complexities of the task before us. No single issue defines health care, and no single issue—whether it be a public health insurance plan, comparative effectiveness research, or reconciliation language—should derail it.